HomeMy WebLinkAboutContractor AffidavitPERMIT # ISSUE DATE
o l Q- .2.3
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
N e/Individual Name)
the t,1
(Type of Trade)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub-contractorfor 61— >'Z � 6c, ,C,
(Primary ntractor)
For the project located at o� $ U� sill L' L) �t 1' !: +; erg �, -/ %`y —
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
L� .
CONtQXCTOR. SIGNATURE (Qualifier)
76(.,LA, L
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of STLu c-' t
nThe foregoing instrument was signed before me this 23 day of
KtAs440' 201(,by VOUA-iy Or-4-0,
who is personally known o has produced a
as identification. /J
pA / 1 STAMP
ignature of Notary Public
Print Name of Notary Public
tiV''A�*. JONATNANDREXFORD
P N Notary Public - State of Florida
Revised 1 1/16/2016 ?� "- Commission : GG 9a8388
o� n,: My Comm, Expires Apr 19, 2024
Bonded through Natloral Notarya—
SUB -CONTRACTOR SIGNATURE (Qualifier)
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before me this _ day of
, 20_, by
who is personally known _or has produced a
as identification.
Signature of Notary Public
Print Name of Notary Public
STAMP
PERMIT # ISSUE DATE (L— ,2.3 2
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
f f ec" have agreed to be
Company ame/Individual Name)
the Sub -contractor for p 6 e P-
(f4eofTrade) % (Primary ntractor)
For the project located at t� pj Po 5 o? e P !1 R�� i` I 4' i erg,94J, ,�/ 3 -r Z�e
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice..
C� CPOR SIGNATURE (Qualifier)
Tot, L
PRINT NAME
/' c(', 1 �-1i,30t., o
eb-UNTY CERTIFICATION NUMBER
State of Florida, County of STI-ac'
The foregoing instrument was signed before me this oZ 35 day of
Qtf*hXl 202t,by UVV'A- (T(drga
who is personally known has produced a
as identification.
STAMP
guature of Notary Publ
I-D resl-�-L. A., V). 0 e.,c %b 1-1
Print Name of Notary Public
Em
JONATHAN 0 REXFORD
Notary Public . State of Florida
Comissionx GG948388
My Comm. Expires Apr 19, 2024
Revised 11/16/2016 Bonded through National Notary Assn.
S ci -P--
SUB -CONTRACTOR SIGNATURE (Qualifier)
NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before me this day of
, 20_, by
who is personally known or has produced a
as identification.
Signature of Notary Public
Print Name of Notary Public
STAMP
PERMIT# ISSUE DATE
23-2/
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
(� e /,? �- c� A�� ee�p� � (
have agreed to be
(ComWy Namelndiv' ual Name)
the 141 a -a. t--2 C/'-X_ Sub -contractor for D �55 GC a
(Type of Trade) (Primary ntractor)
For the project located at o� ?L"r FT, 9' i erC. f,'FJ 3
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
CANT CTOR SIGNATURE (Qualifier)
r
PRINT NAME
�.a
COUNTY CERTIFICATION NUMBER
State of Florida, County of 51—LRC""-
The foregoing instrument was signed before me this ,2 33 day of
�C1M14)k 20Z\ by 3'QVN �-t OW -
who is personally known -'or has produced a
as identification.
✓� A� 1 STAMP
nature of Notary Public
Print Name of Notary Public
SUB -CONTRACTOR SIGNATURE (Qualifier)
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before me this day of
, 20_, by
who is personally known _or has produced a
as identification.
Signature of Notary Public
�uM JONATHAN 0 REXFORD
Revised 1 I/)6/2016 I Notary Public • state of Florida
Commission too 948)88
OjM1 My Comm, Expires 19. 2024
Bonded through Nat'cnal N"Ary Assn,
Print Name of Notary Public
STAMP